6.1 Inflammatory bowel diseases and irritable bowel syndrome

Inflammatory bowel diseases and irritable bowel syndrome are chronic conditions affecting the digestive system. These disorders cause significant discomfort and can impact daily life, requiring ongoing management and lifestyle adjustments.

Nurses play a crucial role in caring for patients with these conditions. From pain management and nutrition support to providing education on treatment adherence and lifestyle modifications, nurses help patients navigate the challenges of living with chronic bowel disorders.

Inflammatory Bowel Diseases

Crohn's vs ulcerative colitis

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• Crohn's disease
  • Pathophysiology involves transmural inflammation of any part of the gastrointestinal tract with discontinuous, patchy lesions and skip areas (jejunum, ileum)
    • Granulomas and fistulas may develop due to deep inflammation
  • Clinical manifestations include abdominal pain, diarrhea, weight loss, fever
    • Perianal disease, fistulas, and abscesses are common complications
    • Extraintestinal manifestations involve arthritis, uveitis, erythema nodosum (skin lesions)
  • Treatment involves corticosteroids for acute flares (prednisone)
    • Immunomodulators and biologic agents used for maintenance therapy (azathioprine, infliximab)
    • Surgery may be necessary for complications or refractory disease
• Ulcerative colitis
  • Pathophysiology involves mucosal inflammation limited to the colon with continuous lesions starting from the rectum and extending proximally
    • Pseudopolyps may develop due to repeated cycles of inflammation and healing
  • Clinical manifestations include bloody diarrhea, abdominal pain, urgency, tenesmus (feeling of incomplete evacuation)
    • Extraintestinal manifestations involve arthritis, uveitis, primary sclerosing cholangitis (liver disease)
  • Treatment involves aminosalicylates for mild to moderate disease (mesalamine)
    • Corticosteroids used for acute flares (hydrocortisone)
    • Immunomodulators and biologic agents used for maintenance therapy (6-mercaptopurine, vedolizumab)
    • Surgery (colectomy) may be necessary for severe, refractory, or dysplastic disease

Nursing care for inflammatory bowel disease

• Pain management
  • Assess pain intensity, location, and characteristics using pain scales (numeric rating scale)
  • Administer prescribed analgesics and monitor effectiveness (acetaminophen, opioids)
  • Encourage non-pharmacological pain relief techniques like relaxation, heat application (warm compress)
• Nutrition
  • Collaborate with a registered dietitian to develop an individualized nutrition plan tailored to the patient's needs and preferences
  • Encourage small, frequent meals and avoidance of trigger foods (spicy foods, high-fiber foods)
  • Monitor nutritional status and supplement with enteral or parenteral nutrition if needed (nasogastric tube, total parenteral nutrition)
  • Educate the patient on the importance of maintaining adequate hydration to prevent dehydration
• Psychosocial support
  • Assess the patient's coping mechanisms and emotional well-being using validated tools (Hospital Anxiety and Depression Scale)
  • Provide emotional support and encourage open communication with the healthcare team and loved ones
  • Refer to mental health professionals or support groups as needed (psychologist, Crohn's & Colitis Foundation)
  • Educate the patient and family on stress management techniques (deep breathing, progressive muscle relaxation)

Irritable Bowel Syndrome

Management of irritable bowel syndrome

• Diagnostic criteria (Rome IV)
  • Recurrent abdominal pain, on average, at least 1 day per week in the last 3 months, associated with two or more of the following:
    1. Related to defecation (improves or worsens with bowel movements)
    2. Associated with a change in frequency of stool (diarrhea or constipation)
    3. Associated with a change in form (appearance) of stool (hard or loose stools)
  • Symptom onset at least 6 months prior to diagnosis
• Management strategies
  • Dietary modifications
    • Low FODMAP diet: reducing fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (wheat, dairy, certain fruits and vegetables)
    • Avoidance of trigger foods like spicy foods, caffeine, alcohol
    • Increasing soluble fiber intake gradually (oats, psyllium)
  • Stress reduction techniques
    • Relaxation techniques like deep breathing, progressive muscle relaxation
    • Regular exercise and physical activity (walking, yoga)
    • Cognitive-behavioral therapy to address maladaptive thoughts and behaviors
    • Medications as prescribed (antispasmodics like dicyclomine, antidepressants like amitriptyline)

Patient education for chronic bowel conditions

• Chronic nature of the diseases
  • Explain that IBD and IBS are long-term conditions that require ongoing management
  • Discuss the potential for periods of remission and relapse (flare-ups)
• Adherence to treatment plans
  • Emphasize the importance of taking medications as prescribed to control symptoms and prevent complications
  • Encourage regular follow-up appointments with healthcare providers to monitor disease activity and adjust treatment as needed
  • Discuss the potential consequences of non-adherence such as disease progression, complications (strictures, fistulas)
• Lifestyle modifications
  • Stress the importance of maintaining a healthy diet and avoiding trigger foods identified through symptom tracking
  • Encourage regular exercise and stress management techniques to improve overall well-being and reduce symptom severity
  • Discuss the impact of smoking on IBD and encourage smoking cessation using nicotine replacement therapy or other methods
• Support and resources
  • Provide information on support groups and patient advocacy organizations (Crohn's & Colitis Foundation, International Foundation for Gastrointestinal Disorders)
  • Encourage open communication with family members and loved ones about the challenges of living with a chronic bowel condition
  • Offer educational materials and resources for further learning (brochures, websites, mobile apps)